| NPI | 1528729258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 15333) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010599) |
| Enumeration Date | 2022-01-05 |
| Last Update Date | 2022-10-10 |